Polypharmacy refers to the use of a patient. The term can be used when too many forms of medication are used by a patient, more drugs are prescribed than clinically warranted,or even when all prescribed medications are clinically indicated but there are too many pills to take (pill burden). The common result of polypharmacy is increased adverse drug reactions and higher costs. This often results when people go to multiple physicians or pharmacies for their medical/medication needs, but can happen when someome only sees one doctor, as well. Severe adverse drug effects can result in serious life-threatening situations. Polypharmacy is most common among the elderly, but can potentially affect anyone taking more than one medication.

It has become increasingly important as doctors, nurses, and patients to be aware of what medication or multiple medications are being prescribed and used. Teachingand learningabout the medications and their reason for use, drug interactions, adverse side effects, interrelationships, and how to go about your daily life while maximizing the benefits of taking them has become absolutely necessary. Patients that have chronic health problems are at great risk of polypharmacybecause they are probably seeing their primary care physician, other medical specialists, and emergency room doctors. This can become serious and life-threatening unless we become more aware of our medical needs and medication use. Often chronic illnesses require multiple medications for treatment and that increases the chance of drug-drug interactions and adverse side-effects. Nurses play a functional role in assisting patients to understand the dangers of polypharmacy. Nurses, through their knowledge and effort, assisting and teaching patients will make a difference and hopefully reduce and prevent serious drug consequences.

Here is a video that makes some alarming statements about polypharmacy, the first minute applies to our topic, the rest of the video touches on other topics.

Shockingly enough, even children make up the growing number of people at risk for polypharmacy. “This is a critical issue—it’s not uncommon to find a child on an anti-depressant, a mood stabilizer and a sleep agent all at the same time, but there’s no research to see how these drugs interact with each other” says Joseph Penn, MD (http://www.lifespan.org/news/2005/08/bh_polypharmacy_8_1_05.htm). There has been a steady increase in the practice of prescribing multiple medications for children, with no studies showing a justification for it.

Apparently it is common practice for doctors to use off-label prescriptions for children. This in and of itself is potentially dangerous because the FDA hasn’t even approved these medications for children and then children are given more than one of them. Child psychiatrist, Joseph Penn states “We just don’t have the efficacy or safety data to back up what is common clinical practice.” (http://www.ahrp.org/infomail/05/08/03b.php) The Alliance for Human Research Protection (AHRP) reports that “America’s children are being put at risk of suicide and cardiac arrest and diabetes –all to increase profits”.

This is terrifying to us, as parents and as humans. It is the responsibility of us adults to protect our children from dangers. We are in complete control over the medications given to our children, and it is our duty to be aware of the potential consequences, good and bad, that may come to our children as a result of the medications we give them. Joseph Penn also advises parents not to “passively accept whatever doctors recommend for children with behavior or psychiatric problems.”

If our children are prescribed medications, we should ask:

Is the drug approved by the Food and Drug Administration, and for what conditions is it approved?

Is it approved for use by children?

What are the short- and long-term benefits and risks of the drug?

Are there any interactions this drug has with other medicines?

How long will my child need to be on the drug?

Are there any side effects I should be looking for to report back to the doctor?

This is a picture of a weekly pill box. It has compartments for each day of the week and spots for up to four times a day. This is a very common box used for psychiatric patients. When I worked at an MHMR center (mental health mental redardation) I had quite a few clients that used these med boxes, and they had pills in almost all of the slots. It is very common practice for a psychiatrist to prescribe multiple medications of similar nature and different kinds (i.e. an antidepressant and an antipsychotic) of medications to a single patient.

It became common for doctors to begin using medications to treat severe mental illness in the 1960s and by 1970 multiple medications were being used to treat an individual. By the 80s, polypharmacy had decreased and wasn’t much of an issue. But the 90s saw the birth of a new generation of antipsychotics and other psychiatric medications. This has allowed, through the use of polypharmacy, many patients who were previously unresponsive to a single medication greatly improve their quality of life by taking multiple medications of similar nature. This seems to be a mixed blessing. I’ve personally seen many people acheive things they never thought they would, with the help of their medication. I’ve also seen people so disabled by the side effects, alone, that they questioned which was worse, their side effects or there equally debilitating symptoms.

Unfortunately, as we all age our bodies start to grow old with us. Arthritis kicks in, consitpation, diarrhea, our hearts get worn, our kidneys get tired, we forget important things. In this day and age there seems to be a medication for everything and a commercial for all of them. Our doctors don’t seem hesitant to prescribe a battery of medications for our high blood pressure and cholesterol, for our bloating, and for our digestive issues. Those medications cause your hands to shake and you have dry mouth? Here’s another medication for your side effects. Can’t remember to take all those meds, don’t worry, you’ll get sent home with a giant med box and another medication for memory. Because as we age our health seems to worsen, the elderly are at particular risk for not only polypharmacy, but also more vulnerable to the associated risks that come along with polypharmacy.

As we age, we seem to lose all the important mechanisms we need for medication regulation. We increase our subcutaneous fat and decrease our lean muscle mass, therefore increasing our risk of toxicity with a drug. Our blood protein, albumin, which is important to many medications as they bind with albumin, drops. This results in a higher concentration of drug floating freely in the blood. This also increases our risk of toxicity.

Here is a very informative power point presentation about polypharmacy and the elderly, check it out. coa.kumc.edu/GEC/password/PowerPointPresentations/Polyphar.ppt

Most everyone is well aware of Heath Ledger’s untimely death. After what seemed like a lot of debate and investigation, his death was declared accidental due to polypharmacy. Heath’s toxicololgy report concluded that he died as the result of “acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam (Valium), temazepam (Restoril), alprazolam (Xanax) and doxylamine (an antihistamine used to treat insomnia and is found in NyQuil).”

Elvis was all to familiar with the world of polypharmacy. There are many different speculations about the death of Elvis. Some say he died of a heart attack, some say he didn’t really die at all! Many people tend to believe he died due to polypharmacy. It was found that Elvis’ doctor had prescribed more than 10,000 doses of sedatives, amphetamines, and narcotics in the first eight months of 1977 alone, all in Elvis’ name (that is 41 doses a day!)

I don’t know to many fans of Hitler, but he, too, was known to take many, many different medications. He has been rumored to have had syphilis, schizophrenia, GI issues, insomnia, Parkinson’s, and an expert in austism spectrum disorders reported that Hitler met all the criteria of Asperger Syndrome. Regardless of what Hitler may or may not have had, it has been well documented that he was taking multiple medications simultaneously. Wikipedia states that by April 1945, Hitler was taking 28 different pills a day along with numerous injections (including many of glucose) every few hours and intravenous injections of methamphetamine at least one almost every day. That seems like it could really effect one’s decision making skills and rational thought… too bad he was trying to take over the world!

Polypharmacy is characterized by drug duplication, interaction, or both. The good news is, you can prevent it yourself with a little education and preparation. Here are some simple tips for avoiding polypharmacy:

1.Always read labels. They may tip you off to possible drug interactions

2.Use only one pharmacy to fill prescriptions

3.Learn your medications by name and what they are for

4.Make a list of all your medications including pill strength and dose, as well as herbal products, vitamins, supplements, and over-the-counter drugs. Update it after every doctor visit

5.Carry your medications list everywhere. Bring it every doctor visit, along with the pill bottles

6.If you have more than one doctor, make sure each one knows what the other is prescribing

7.Ask your primary caregiver or pharmacist to run your medication list through a drug interactions database to identify possible problems, especially if you’re on five or more drugs

8.Avoid combination products such as cold formulas. Ask your pharmacist to help you find a product just for the symptoms you’re experiencing – not for every possible symptom

9.Never take a new drug without asking your pharmacist about its side effects and interactions with other drugs

10.Get familiar with your medications. Learn about them from your physician or pharmacist, or learn to use a Physician’s Desk Reference, available in your local library. Books about prescription drugs are also available at your local bookstore. Don’t trust the internet; much of the information available on-line is from questionable sources